The Retrograde Migration of Foreign Bodies inside the Female Genital Tract: A Step-by-Step Hysteroscopic Approach

Foreign bodies within the female genital tract are uncommon findings that may remain asymptomatic or undetected for extended periods. In rare instances, these objects undergo retrograde migration towards the uterine cavity, creating diagnostic and therapeutic challenges. Such occurrences may follow self-insertion, accidental introduction, or retention of materials after medical or hygienic procedures. We describe two illustrative cases managed successfully with a minimally invasive hysteroscopic approach combining electrosurgical radial incision and Foley catheter-assisted mechanical dilation. A 12-year-old postmenarchal nulliparous girl presented with intermittent vaginal discomfort and foul-smelling vaginal discharge and imaging evidence of a round object in the upper vagina. Hysteroscopy revealed a cosmetic spray bottle cap embedded within a fibrous ring close to the cervix. After failed grasping attempts, controlled radial incisions were performed in the fibrotic tissue surrounding the cap with a 5Fr bipolar needle-tip electrode, followed by overnight dilation using a Foley catheter inflated with 30 mL of saline. The object was easily removed the following day without trauma. The second case involved a 39-year-old multiparous woman with suspected retention of a vaginal douche cap, later visualized within the uterine cavity on hysteroscopy. After unsuccessful extraction, the previously described stepwise technique enabled the safe removal of the foreign body following overnight dilation. Both patients had uneventful recoveries. This combined method provides direct visualization, controlled cervical access, and progressive tissue dilation, reducing the risk of perforation or laceration. The presented technique offers a minimally invasive alternative to blind or forceful extraction attempts, particularly useful in children and nulliparous patients or icn cases of cervical stenosis.